title: Preferences for resuscitation and intubation among patients with do-not-resuscitate/do-not-intubate orders.
abstract: OBJECTIVE
  To determine the accuracy of do-not-resuscitate/do-not-intubate (DNR/DNI) orders in representing patient preferences regarding cardiopulmonary resuscitation (CPR) and intubation.
  
  
  METHODS
  We conducted a prospective survey study of patients with documented DNR/DNI code status at an urban academic tertiary care center that serves approximately 250,000 patients per year. From October 1, 2010, to October 1, 2011, research staff enrolled a convenience sample of patients from the inpatient medical service, providing them with a series of emergency scenarios for which they related their treatment preference. We used the Kendall τ rank correlation coefficient to examine correlation between degree of illness reversibility and willingness to be resuscitated. Using bivariate statistical analysis and multivariate logistic regression analysis, we examined predictors of discrepancies between code status and patient preferences. Our main outcome measure was the percentage of patients with DNR/DNI orders wanting CPR and/or intubation in each scenario. We hypothesized that patients with DNR/DNI orders would frequently want CPR and/or intubation.
  
  
  RESULTS
  We enrolled 100 patients (mean ± SD age, 78 ± 13.7 years). A total of 58% (95% CI, 48%-67%) wanted intubation for angioedema, 28% (95% CI, 20%-3.07%) wanted intubation for severe pneumonia, and 20% (95% CI, 13%-29%) wanted a trial resuscitation for cardiac arrest. The desire for intubation decreased as potential reversibility of the acute disease process decreased (Kendall τ correlation coefficient, 0.45; P<.0002).
  
  
  CONCLUSIONS
  Most patients with DNR/DNI orders want CPR and/or intubation in hypothetical clinical scenarios, directly conflicting with their documented DNR/DNI status. Further research is needed to better understand the discrepancy and limitations of DNR/DNI orders.
authors.affiliation: Department of Emergency Medicine, Christiana Care Health Center, Newark, DE. Electronic address: jjesus@christianacare.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Jesus
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Allen
authors.forename: Glen E
authors.initials: GE
authors.lastname: Michael
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.forename: Shamai A
authors.initials: SA
authors.lastname: Grossman
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Hale
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Breu
authors.forename: Alexander
authors.initials: A
authors.lastname: Bracey
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: O'Connor
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000523:psychology / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D007440:Intubation / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016414:Resuscitation Orders / Q000523:psychology